The phenomenon refers to any addictive behavior that serves at least one
key function previously achieved by another addictive behavior (e.g.,
relaxation, escape, excitement, pleasure, reduction of negative affect, social
lubrication; e.g. Zweben, 1987). It describes situations in which people
substitute one form of addiction with another during recovery. This may involve
substituting drug for drug, drug for behavior or vice versa, or behavior for a
behavioral addiction. Examples include Benzodiazepine substituting alcohol,
overeating for smoking, exercise for gambling, sex for opioid addiction, and so
on. Last year a group from Columbia University and the New York Psychiatric
institute published the first epidemiological survey that examined whether
remission from one SUD predicts new onset of another SUD (Blanco et al., 2014).
Despite the authors’ assertion that it did not predict such a change, they
concede in the limitation the following: they relied on self-reporting by
patients, no urinalysis was done and short follow up period.
What they did not concede was the
omission of substitution to behavioral or process addictions. This is
surprising given the wellestablished evidence of involvement of the
dopaminergic neurons in the mesocorticolimbic reward system of the brain
(ventral tegmental area via Nucleus accumbens) in both SUDs and process
addictions, leading to the assumption that the same mechanisms involved in
substituting drug for drug may be involved in substituting behavior for drug.
Despite these, limitations they found one fifth of the nationallyrepresentative sample of 34 653 adults from the National Epidemiologic Survey
on Alcohol and Related Conditions in the US, approximately one-fifth (n = 2741)
of the total sample had developed a new-onset SUD at the wave 2 assessment. To
me this proves the point, rather than refute it.
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